Thane M. Erickson

Preliminary Reliability and Validity of the Generalized Anxiety Disorder Questionnaire - IV: A Revised Self-Report Diagnostic Measure of Generalized Anxiety Disorder

This study examined the Generalized Anxiety Disorder Questionnaire-IV (GAD-Q-IV), a revised self-report diagnostic measure of generalized anxiety disorder (GAD) based on the fourth edition of the Diagnostic and Statistical Manual. GAD-Q-IV diagnoses were compared to structured interview diagnoses of individuals with GAD, social phobia, panic disorder, and nonanxious controls. Using Receiver Operating Characteristics analyses, the GAD-Q-IV showed 89% specificity and 83% sensitivity. The GAD-Q-IV also demonstrated test-retest reliability, convergent and discriminant validity, and kappa agreement of .67 with a structured interview. Students diagnosed with GAD by the GAD-Q-IV were not significantly different on two measures than a GAD community sample, but both groups had significantly higher scores than students identified as not meeting criteria for GAD, demonstrating clinical validity of the GAD-Q-IV.

A PILOT STUDY OF GROUP MINDFULNESS-BASED COGNITIVE THERAPY (MBCT) FOR COMBAT VETERANS WITH POSTTRAUMATIC STRESS DISORDER (PTSD)

“Mindfulness‐based” interventions show promise for stress reduction in general medical conditions, and initial evidence suggests that they are accepted in trauma‐exposed individuals. Mindfulness‐based cognitive therapy (MBCT) shows substantial efficacy for prevention of depression relapse, but it has been less studied in anxiety disorders. This study investigated the feasibility, acceptability, and clinical outcomes of an MBCT group intervention adapted for combat posttraumatic stress disorder (PTSD).

Worry and Generalized Anxiety Disorder: A Review and Theoretical Synthesis of Evidence on Nature, Etiology, Mechanisms, and Treatment

Generalized anxiety disorder (GAD) is associated with substantial personal and societal cost yet is the least successfully treated of the anxiety disorders. In this review, research on clinical features, boundary issues, and naturalistic course, as well as risk factors and maintaining mechanisms (cognitive, biological, neural, interpersonal, and developmental), are presented. A synthesis of these data points to a central role of emotional hyperreactivity, sensitivity to contrasting emotions, and dysfunctional attempts to cope with strong emotional shifts via worry. Consistent with the Contrast Avoidance model, evidence shows that worry evokes and sustains negative affect, thereby precluding sharp increases in negative emotion. We also review current treatment paradigms and suggest how the Contrast Avoidance model may help to target key fears and avoidance tendencies that serve to maintain pathology in GAD.

Effects of perceived control and cognitive coping on endocrine stress responses to pharmacological activation.

BACKGROUND The hypothalamic-pituitary-adrenal (HPA) axis may mediate negative health effects of stress. It is sensitive to cognitive/emotional factors like novelty, perceived control, and coping. Psychological intervention that reduces novelty and enhances cognitive coping and sense of control can reduce cortisol responses to pentagastrin, a pharmacological HPA activator. This study attempted to identify the core factors that modulate HPA axis activity in this model. METHODS Varying instructions were administered prior to drug exposure in a two-visit (placebo first) pentagastrin infusion paradigm. Healthy subjects (n = 40) were randomly assigned to one of four instruction groups: 1) standard instruction (SI); 2) full cognitive intervention (CI); 3) the CI control component alone; or 4) the CI novelty reduction/coping components alone. Blood samples were obtained via intravenous catheter before and after pentagastrin. RESULTS Subjects receiving an intervention had smaller cortisol responses than subjects receiving standard instructions. Coping alone had as strong an impact as the more complex intervention that combined coping and control. Control alone also reduced cortisol but its HPA impact appeared less robust. CONCLUSIONS Brief psychological manipulation can significantly reduce HPA activation in challenge paradigms. Cognitive preparation that focused on side effects, reduced potential surprise, and enhanced cognitive coping modulated HPA axis activity as effectively as a previously tested intervention that combined coping and control manipulations. A sense of control alone also reduced cortisol release. The results support development of control or coping techniques to combat negative health effects of stress that are mediated by HPA axis activation.

Using Structural Analysis of Social Behavior (SASB) Measures of Self- and Social Perception to Give Interpersonal Meaning to Symptoms Anxiety as an Exemplar

Current symptom-based diagnosis, although important, lacks theoretical underpinning that might give meaning to psychiatric symptoms. The structural analysis of social behavior (SASB) fills this void, operationalizing interpersonal theory for investigation of relational aspects of psychopathology. To provide an example of how SASB may be utilized to this end, participants with (n = 40) and without (n = 40) uncontrollable worry and anxiety completed SASB Intrex Questionnaires to explore self-perceptions and perceptions of strangers in a social interaction task. Based on SASB principles and past research on familial factors in childhood anxiety, it was hypothesized that self- and other perceptions would discriminate participant groups along the lines of disrupted and normal attachment. To demonstrate the versatility of SASB, analyses incorporated indexes of varying specificity. Largely, results supported predictions, suggesting the sensitivity of SASB Intrex to assess social perceptions even in a first-meeting context, extending its known possible uses.

Cognitive behavioral psychotherapy for generalized anxiety disorder: a primer

Generalized anxiety disorder is a highly debilitating psychologic disorder associated with cognitive, affective, behavioral and physiologic forms of rigidity and dysfunction. Chronic and uncontrollable worry, a future-oriented and highly negative form of verbal thought, is its hallmark symptom. Cognitive behavioral therapy, the most well-established psychologic treatment for generalized anxiety disorder, entails techniques designed to target and reduce dysfunction in each of these mutually interrelating domains. This review serves as an introduction to cognitive behavioral therapy for generalized anxiety disorder, including conceptualization, treatment methods and evidence for efficacy. Future directions for augmenting treatment efficacy are also discussed.

Interpersonal Problems Predict Differential Response to Cognitive Versus Behavioral Treatment in a Randomized Controlled Trial

OBJECTIVE We examined dimensional interpersonal problems as moderators of cognitive behavioral therapy (CBT) versus its components (cognitive therapy [CT] and behavioral therapy [BT]). We predicted that people with generalized anxiety disorder (GAD) whose interpersonal problems reflected more dominance and intrusiveness would respond best to a relaxation-based BT compared to CT or CBT, based on studies showing that people with personality features associated with a need for autonomy respond best to treatments that are more experiential, concrete, and self-directed compared to therapies involving abstract analysis of ones problems (e.g., containing CT). METHOD This was a secondary analysis of Borkovec, Newman, Pincus, and Lytle (2002). Forty-seven participants with principal diagnoses of GAD were assigned randomly to combined CBT (n = 16), CT (n = 15), or BT (n = 16). RESULTS As predicted, compared to participants with less intrusiveness, those with dimensionally more intrusiveness responded with greater GAD symptom reduction to BT than to CBT at posttreatment and greater change to BT than to CT or CBT across all follow-up points. Similarly, those with more dominance responded better to BT compared to CT and CBT at all follow-up points. Additionally, being overly nurturant at baseline was associated with GAD symptoms at baseline, post, and all follow-up time-points regardless of therapy condition. CONCLUSIONS Generally anxious individuals with domineering and intrusive problems associated with higher need for control may respond better to experiential behavioral interventions than to cognitive interventions, which may be perceived as a direct challenge of their perceptions.

Viral videos and virtue: Moral elevation inductions shift affect and interpersonal goals in daily life

Abstract Laboratory studies suggest that witnessing virtuous acts triggers moral elevation, an emotion characterized by feeling uplifted and increased prosocial motives. However, it remains unknown whether regular inductions can increase elevation and prosocial motives in daily life without being vulnerable to habituation or adaptation effects. Participants (total N = 181) were randomly assigned to elevating vs. neutral or amusing inductions (video or recall tasks) for seven days (Study 1), ten days (Study 2), or 12 days over one month (Study 3). Multilevel growth models showed that relative to comparison conditions, elevation inductions increased daily elevation, positive affect, and prosocial outcomes (compassionate goals and affiliation), and decreased self-protective motives (self-image goals). Adaptation effects occurred for immediate responses when exercises occurred daily, but not when spaced out over time, and not for outcomes measured later each day. Results suggest benefits of brief, regular elevation experiences and have implications for interventions targeting specific emotions.

Prospective Investigation of the Contrast Avoidance Model of Generalized Anxiety and Worry

The factors that maintain generalized anxiety disorder (GAD) symptoms and worry over time are not entirely clear. The Contrast Avoidance Model (CAM) postulates that individuals at risk for pathological worry and GAD symptoms uniquely fear emotional shifts from neutral or positive emotions into negative emotional states, and consequently use worry to maintain negative emotion in order to avoid shifts or blunt the effect of negative contrasts. This model has received support in laboratory experiments, but has not been investigated prospectively in the naturalistic context of daily life. The present study tested the CAM in a longitudinal experience sampling study with a subclinical sample. Participants selected to represent a broad range of symptoms (N = 92) completed baseline measures of GAD and depression symptoms, and eight weekly assessments of worry, experiences of negative emotional contrasts during their worst event of the week, and situation-specific negative emotion. Consistent with the CAM, GAD symptoms prospectively predicted higher endorsement of negative contrast experiences as worst events, independent of depression symptoms. Unsurprisingly, higher negative contrasts predicted higher negative emotion. However, both higher baseline GAD symptoms and weekly worry uniquely moderated (reduced) this relationship, providing consistent support for the idea that worry may blunt the emotional effects of contrasts. Depression symptoms did not have the same moderating effect. These findings support the CAM in an ecologically valid context.

Moral elevation and compassionate goals predict posttraumatic growth in the context of a college shooting

Abstract After a mass shooting, community members may experience not only distress, but also feeling uplifted or morally elevated by others’ prosocial responses to the trauma. Those experiencing elevation may be more likely to strive to support others (compassionate goals) and to endorse posttraumatic growth (PTG). However, the role of elevation in PTG, and the relative contribution of compassionate goals (both from and toward others), remains unknown. Students, faculty, and staff (N = 385) completed measures four months after a campus shooting, and a subset repeated measures at eight months (n = 82). As expected, compassionate goals toward others incrementally predicted higher PTG beyond perceptions of compassionate goals from others. Also, elevation concurrently and prospectively predicted higher PTG. Lastly, elevation mediated effects of others’ compassionate goals on PTG, as hypothesized (95% CI = 2.59 to 5.43). These findings have implications for understanding the social and emotional processes that facilitate PTG.